The population effect of a national policy to incentivize chronic disease management in primary care in stroke: a population-based cohort study using an emulated target trial approach

Andrew, Nadine E.; Ung, David; Olaiya, Muideen T.; Dalli, Lachlan L.; Thrift, Amanda G.; Чурилов, Леонид; Sundararajan, Vijaya; Thrift, Amanda G; Cadilhac, Dominique A.; Nelson, Mark; Lannin, Natasha A.; Barnden, Rebecca; Srikanth, Velandai; Kilkenny, Monique F

doi:10.1016/j.lanwpc.2023.100723

Cited by 5 publications

(7 citation statements)

References 32 publications

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“…To maximize capture, we also considered any Medicare benefits schedule items that were specifically claimed for services provided to aged care residents—validated in the main PRECISE study (Figure 1). 13…”

Section: Methodsmentioning

confidence: 99%

Factors Associated With Transition From Community to Permanent Residential Aged Care Following Stroke: A Linked Registry Data Study

Westworth,

Ung,

Dalli

et al. 2023

Stroke

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BACKGROUND: Understanding factors that influence the transition to permanent residential aged care following a stroke or transient ischemic attack may inform strategies to support people to live at home longer. We aimed to identify the demographic, clinical, and system factors that may influence the transition from living in the community to permanent residential care in the 6 to 18 months following stroke/transient ischemic attack. METHODS: Linked data cohort analysis of adults from Queensland and Victoria aged ≥65 years and registered in the Australian Stroke Clinical Registry (2012–2016) with a clinical diagnosis of stroke/transient ischemic attack and living in the community in the first 6 months post-hospital discharge. Participant data were linked with primary care, pharmaceutical, aged care, death, and hospital data. Multivariable survival analysis was performed to determine demographic, clinical, and system factors associated with the transition to permanent residential care in the 6 to 18 months following stroke, with death modeled as a competing risk. RESULTS: Of 11 176 included registrants (median age, 77.2 years; 44% female), 520 (5%) transitioned to permanent residential care between 6 and 18 months. Factors most associated with transition included the history of urinary tract infections (subhazard ratio [SHR], 1.41 [95% CI, 1.16–1.71]), dementia (SHR, 1.66 [95% CI, 1.14–2.42]), increasing age (65–74 versus 85+ years; SHR, 1.75 [95% CI, 1.31–2.34]), living in regional Australia (SHR, 31 [95% CI, 1.08–1.60]), and aged care service approvals: respite (SHR, 4.54 [95% CI, 3.51–5.85]) and high-level home support (SHR, 1.80 [95% CI, 1.30–2.48]). Protective factors included being dispensed antihypertensive medications (SHR, 0.68 [95% CI, 0.53–0.87]), seeing a cardiologist (SHR, 0.72 [95% CI, 0.57–0.91]) following stroke, and less severe stroke (SHR, 0.71 [95% CI, 0.58–0.88]). CONCLUSIONS: Our findings provide an improved understanding of factors that influence the transition from community to permanent residential care following stroke and can inform future strategies designed to delay this transition.

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Section: Methodsmentioning

confidence: 99%

Factors Associated With Transition From Community to Permanent Residential Aged Care Following Stroke: A Linked Registry Data Study

Westworth,

Ung,

Dalli

et al. 2023

Stroke

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“…This number will be used without any re-estimation of power. Using the observed data on retention rate (currently 93%), and more recent data on unplanned hospital presentations/readmissions from another study [ 10 ], our sample may provide sufficient power for a 10% difference in the primary outcome.…”

Section: Methodsmentioning

confidence: 99%

Statistical analysis plan for the Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke randomised controlled clinical trial

Kilkenny,

Olaiya,

Cameron

et al. 2024

Trials

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Background Unplanned hospital presentations may occur post-stroke due to inadequate preparation for transitioning from hospital to home. The Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) trial was designed to test the effectiveness of receiving a 12-week, self-management intervention, comprising personalised goal setting with a clinician and aligned educational/motivational electronic messages. Primary outcome is as follows: self-reported unplanned hospital presentations (emergency department/admission) within 90-day post-randomisation. We present the statistical analysis plan for this trial. Methods/design Participants are randomised 1:1 in variable block sizes, with stratification balancing by age and level of baseline disability. The sample size was 890 participants, calculated to detect a 10% absolute reduction in the proportion of participants reporting unplanned hospital presentations/admissions, with 80% power and 5% significance level (two sided). Recruitment will end in December 2023 when funding is expended, and the sample size achieved will be used. Logistic regression, adjusted for the stratification variables, will be used to determine the effectiveness of the intervention on the primary outcome. Secondary outcomes will be evaluated using appropriate regression models. The primary outcome analysis will be based on intention to treat. A p-value ≤ 0.05 will indicate statistical significance. An independent Data Safety and Monitoring Committee has routinely reviewed the progress and safety of the trial. Conclusions This statistical analysis plan ensures transparency in reporting the trial outcomes. ReCAPS trial will provide novel evidence on the effectiveness of a digital health support package post-stroke. Trial registration ClinicalTrials.gov ACTRN12618001468213. Registered on August 31, 2018. SAP version 1.13 (October 12 2023) Protocol version 1.12 (October 12, 2022) SAP revisions Nil

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“…4 6 7 Government policies that provide financial support to PCPs to provide structured chronic disease management improve survival in chronic disease such as stroke and transient ischemic attack. 8 Improved outcomes in primary care are associated with a greater per capita supply of PCPs, 1 and support for structured management of chronic disease, data-driven quality improvement with computerized decision support, and a gatekeeping role to facilitate care coordination and reduce fragmentation are factors that improve health outcomes. Strengthening primary care and increasing access to a PCP also improves outcomes and reduces hospitalization in marginalized populations indicating that primary care is an effective strategy to optimize health equity.…”

Section: Diagnosismentioning

confidence: 99%

The Role of the Primary Care Physician in the Assessment and Management of Polycystic Ovary Syndrome

2023

Semin Reprod Med

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Polycystic ovary syndrome (PCOS) is a complex and heterogeneous female endocrine disorder with manifestations that span the hormonal, reproductive, metabolic, and psychological. Primary care physicians (PCPs), also known as family physicians or general practitioners, play a key role in the diagnosis, assessment, and management of PCOS. This article outlines the role of the PCP in the timely and accurate diagnosis, provision of information and education, lifestyle and weight management, and management of key features such as hyperandrogenism, irregular cycles, infertility, emotional well-being, and cardiometabolic risk. PCPs play an essential role as the point of first contact for women and adolescents with or at high risk of PCOS, providers of whole-person care and continuity of care, and coordinators of care within a multidisciplinary team. Optimal management of PCOS requires equitable access to primary care. There is a need for systemic approaches to addressing barriers to provision of quality primary care, such as poor remuneration of longer consultations and low awareness of evidence-based guidelines, to women and adolescents with PCOS.

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The population effect of a national policy to incentivize chronic disease management in primary care in stroke: a population-based cohort study using an emulated target trial approach

Cited by 5 publications

References 32 publications

Factors Associated With Transition From Community to Permanent Residential Aged Care Following Stroke: A Linked Registry Data Study

Factors Associated With Transition From Community to Permanent Residential Aged Care Following Stroke: A Linked Registry Data Study

Statistical analysis plan for the Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke randomised controlled clinical trial

The Role of the Primary Care Physician in the Assessment and Management of Polycystic Ovary Syndrome

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